Fortnightly Review: Pressure sores

Pressure sores have defied the best attempts of medical and nursing staff since they were first described in Egyptian mummies.'They are defined as a localised area of tissue damage resulting either from direct pressure on the skin causing pressure ischaemia or from shearing forces causing mechanical stress to the tissues.The pathophysiology remains poorly understood.2Pressure sores are painful, unsightly, difficult to treat, and costly.The estimated cost of caring for pressure sores is £150 million a year in the United Kingdom and more than $3 billion in the United States.34A full thickness sacral sore typically involves substantial expenditure in staff time, dressing materials, drugs, and special pressure relieving beds during hospital inpatient care over many months; the estimated total cost per patient is £26 000.' Also, there is the cost to patients in lost income, productivity, and independence, which the patients and their relatives increasingly attempt to recover from health authorities by litigation.67 PrevalenceThe prevalence of pressure sores among hospital inpatients in the United Kingdom is 7-8%; it may be even higher in community medicine.89Elderly people are particularly susceptible, with 70% of all pressure sores occurring in patients aged over 70 years.'0Younger patients usually have an underlying neuro- logical disorder, and patients with cerebral palsy, multiple sclerosis, and spinal cord lesions are par- ticularly susceptible: up to 85% of paraplegics develop a pressure sore."-'3Wheelchair users are also at a special risk, and around a quarter will develop a sore.'